David – case study Sam McCauley Rachael Green Amie Watts Karen Beattie

Introduction to David  David’s in his 20’s and been homeless for around 10 years  History of alcohol abuse  Admitted to A and E with head injury  Malnutrition and feet problems  Aggressive and delusional thoughts

Underlying Factors & Health Issues  Psychological Underlying Factors and issues  Mental Health (Depression, schizophrenia, anxiety, fear, confusion, distress reduced self-esteem, Vulnerability ).  Alcohol and/or substance abuse and addictions  Past experiences  Homelessness  Physical Underlying Factors and issues  Head injury  Self-neglect / poor self-care, malnutrition, fatigue  Poor/no access to primary care  possible repeated brain injury, possible violence  Mobility, feet and musculoskeletal problems, respiratory problems  Liver damage  Social/Societal Manifestations  Stigma, Stereotyping  Reduced social support network, Family/marital breakdown, physical/mental abuse, Bereavement  ‘Revolving door patient’  National/local legislation and policies

Working with David  Attempt to gain trust, Offer reassurance, Be calm/’friendly’  Be professional, Take client-centred approach  Articulate own role/goals/intervention clearly  Obtaining Consent  Enforcement of Mental Health Act (MHA)  Involvement of next-of-kin, family, carer(s)  Information Required -  Previous medical history, Details of NOK/carer(s), Home / address  By interview with David, Police, Voluntary Agencies/NGO’s, Social Services, Charitable organisations  Other Factors/issues  Cultural, Spiritual, Ethnicity  Feelings of low self-esteem perpetuated by ‘uncaring’ society  Access to Healthcare  NHS Walk-In Centres/Helpline  Community Health Teams  Voluntary/Charitable Agencies/Organisations

Goals & Challenges  Short: Addictions/detoxify, Physical problems, Increase self-esteem, Daily structure/routines.  Medium: Effective medication regime, Increase social support network, Group activities.  Long: Achieve independence, Employment (voluntary or paid).  Challenges  Relapse  Side effects of medication  Drug compliance  Society (stigma and prejudice  Addictions  ? social support network  Adjusting into societal ‘norms’  Overcome by –  24 hour crisis team  Short/Medium/Long term strategies

MDT  Professionals  Mental Health Team (CPN, Nursing team, ASW, Consultants) for diagnosis, medication, discharge, physical health needs  Community Mental Health Team  Occupational Therapists for Activities of Daily Living  GP for primary health care needs  Podiatrist  Others  Assertive Outreach  Voluntary Agencies (Crisis, Mind, Hearing Voices)  Community Mental Health Team  Supported Housing  Advantages: Shared Notes, Joint approach, Integrated knowledge.  Disadvantages: Poor communication, Poor time management, Case overload, Too many people/organisations for David, Conflict between professionals/agencies involved.